조기 발병 양극성 장애 환자의 임상적 특징 : 후향적 의무기록 조사 연구

우영섭,박민현,서호준,채정호,전태연,박원명 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5

Objective : Bipolar disorder is a disease with diverse clinical profiles and outcomes. In recent years, it is suggested that if bipolar disorder occurs early in one's life, functional and symptomatic prognoses are poor. The prognoses include severe Symp-toms, frequent psychotic symptoms, comorbidity ofmental illnesses, slow improvement of the symptoms, and high suicide rate. We investigated the clinical characteristics of early onset bipolar inpatients. Method : The subjects of this study were selected from the patients who were discharged after hospitalization between January 1, 2001 and May 31, 2005 and diagnosed with bipolar disorder according to DSM-IV criteria. These patients were examined for the following data ; the type of bipolar disorder, comorbid psychiatric disorders, the age at onset of the illness, the acuteness of the disorder, and the duration of the disorder. The presence of four major clinical psychopathology, rapid cycling, Psychotic symptoms, comorbid psychiatric disorders, and suicide attempt, was also examined. The patients whose onset of the illness was before the age of 19 were classified as the early onset group and after the age of 19 were classified as the late onset group. Data on demographics, family histories, four major clinical psychopathologies and other clinical variables were compared between the early onset group and the late onset group. Results : Of the 53 patients, 19 patients belonged to the early onset group. There was higher incidence ofpsychotic Symp-toms in the early onset group than in the late onset group, and the difference was statistically significant according to the χ² - test (84.2% vs 44.1%, P=0.005). The incidence of comorbid psychiatric disorders was higher in the early onset group than in the late onset group, and the difference was also statistically significant according to the χ²-test (52.6% vs 23.5%, P=0.032).However, there was no statistically significant difFerence between the groups regarding the incidence of rapid cycling and suicide attempt. The result of logistics regression showed correlation of psychotic symptoms (0R=6.756 ; 1.655≤95% CI≤27.580) and comorbid psychiatric disorders (0R=3.611 ; 1.088≤95% CI≤11.984) with the early onset group. Conclusion : Early onset of bipolar disorder is related to the manifestation of psychotic symptoms and frequently accom-panies comorbid psychiatric disorders. The results of this study will help understand the mechanism of the onset of complexbipolar disorder and estimate the prognosis.

Agomelatine: 새로운 기전의 항우울제

우영섭,왕희령,박원명 대한정신약물학회 2014 대한정신약물학회지 Vol.25 No.1

주요 우울증 치료의 1차 선택 약제인 SSRI, SNRI 등은 우울증의 병태생리가 단가아민계의 이상과 관련 있다는 가설에근거한 약물들로서, 그 임상적 효과는 제한적인 것으로 알려져 있다. 우울증의 병태생리와 관련하여 새로운 가설들이 나오고 있으며, 그 중에서 일주기 리듬의 장애가 주요 우울증의발생 기전에 중요한 역할을 한다는 증거들이 제시되면서 일주기 리듬을 정상화시키는 agomelatine의 항우울 효과가 점차 임상적 관심을 모으고 있다. agomelatine은 MT1, MT2 수용체에 선택적 촉진작용과 세로토닌 5-HT2C 수용체에 길항작용을 함으로써, 항우울 효과와 일주기 리듬의 개선 효과를 보이는 것으로 생각되고 있다. 기존의 여러 임상 연구들에서 주요 우울증 환자의 치료에 있어서 agomelatine이 기존의 다른 항우울제들과 비교하여 최소 동등한 항우울 효과를 가진다는 것이 밝혀졌고, 심한우울 증상과 불안 증상의 호전에도 효과적인 것으로 밝혀졌다. 또한 부작용의 측면에서 agomelatine은 높은 내약성과안전성을 보였고, 특히 성기능 장애와 discontinuation syndrome의위험성이 기존의 항우울제들보다 낮은 것으로 보고되었다. 이러한 agomelatine 사용과 관련된 임상 자료의 축적에도불구하고, agomelatine의 작용 기전은 명확하게 밝혀져 있지않다. 이에 agomelatine의 작용 기전을 규명하는 향후 연구들이 진행되어야 할 것이며, 이러한 연구들을 통해 주요 우울증의 병태생리를 좀 더 명확하게 규명할 수 있을 것으로 기대되고 있다. 또한 특수 인구 집단인 소아 및 노인 등에서의 agomelatine의효과, 인지 기능에 미치는 agomelatine의 영향 등에 대한 연구가 보강되어야 할 것이며, 계절성 기분장애, 양극성장애 우울삽화 등 일주기 리듬의 장애와 관련이 있는 다른 정신과적 질환에서의 agomelatine의 연구들도 보다 활발히 이루어져야 할 것으로 보인다. Major depression is a common mental illness, associated with high morbidity and mortality. Antidepressants have been thefirst-line therapies due to their confirmed efficacy, however, considering high rate of poor treatment response to these therapies,distressing side effects, and delayed onset of their efficacy, there has been much effort to find alternative treatments formajor depression. Recently, evidence regarding disturbed circadian rhythms involved in the pathophysiology of major depressionhas emerged, the interest on this area has been increasing. Agomelatine is an emerging antidepressant, with a uniqueprofile of selective antagonist at serotonin 2C (5-HT2C) receptors and melatonin receptor agonist. Previous studies haveshown its superior efficacy over placebo in treating major depression. Previous trials have shown comparable antidepressantefficacy of agomelatine compared to other standard antidepressants including venlafaxine, sertraline, and fluoxetine. Regardingsafety profile of agomelatine, it seems to be not associated with sexual dysfunction and it has less potential for serotoninsyndrome or discontinuation syndrome than standard antidepressants including selective serotonin reuptake inhibitors. Consideringfavorable results on the efficacy and safety of agomelatine in treating depression, it could be a good, safe treatmentalternative in the treatment of depression.

DSM-IV에 의한 주요 우울증의 진단적 안정성

우영섭,이두수,전태연,채정호,김광수,박원명 대한우울조울병학회 2007 우울조울병 Vol.5 No.1

Objective:In this study, we determined the diagnostic stability of major depressive disorder according to the DSM-IV by investigating changes in the main diagnostic picture over time in clinical practice. Method:A medical record review of patients admitted to a university hospital with the diagnosis of major depressive disorder (MDD) in a period from January 2002 to December 2005 was conducted. To evaluate prospective stability, all patients who were diagnosed with MDD at first inpatient contact were identified, and diagnoses at subsequent period of contact were described. To evaluate retrospective stability, all patients diagnosed with MDD at subsequent contacts were identified, and diagnoses at the first contact were described. Results:A total of 233 patients were diagnosed with MDD at least once. Among these, 208 patients were diagnosed at the first contact. In approximately 21% of patients, the initial diagnosis of MDD eventually changed during follow up to other diagnoses. In 120 patients who were diagnosed with MDD at subsequent period, 90.8% of the patients were diagnosed with MDD at the first contact. Conclusions:The diagnosis of depressive disorder was found to have a low prospective stability and a high retrospective stability. (J of Kor Soc for Dep and Bip Disorders 2007;5:25-29)

한국형 양극성 장애 약물치료 알고리듬 2014: 조증 삽화

우영섭,박원명,전덕인,서정석,이정구,정종현,김문두,손인기,심세훈,민경준,윤보현,신영철 대한정신약물학회 2014 대한정신약물학회지 Vol.25 No.2

Objective The pharmacotherapy of bipolar disorder has many difficulties such as various clinical feature according to eachepisode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent rapid developmentand research of bipolar disorder and psychopharmacology, including atypical antipsychotics and new anticonvulsants, makeit more difficult to choose the appropriate pharmacological options. Therefore, we decided to revise the Korean MedicationAlgorithm Project for Bipolar Disorder (KMAP-BP) 2010 in order to provide more proper guideline for clinicians. Methods Like the previous version, KMAP-BP 2010, we performed the survey using questionnaire comprising 55 mainquestions in which 8 main questions and 478 sub-items for treatment of manic or hypomanic episode were included. Sixtyfourmembers of the review committee completed the survey. The executive committee analyzed the results and discussedthe final production of algorithm considering scientific evidence. Results The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and anatypical antipsychotic, and it is the treatment of choice for euphoric, psychotic and dysphoric/mixed mania. The preferencefor monotherapy with atypical antipsychotic (for all three types of mania) or mood stabilizer (for euphoric mania) was increasedin KMAP-BP 2014. Valproic acid and lithium are chosen as the preferred mood stabilizer of the first-line treatment ofacute manic episode and valproic acid was the treatment of choice for all types of mania. Atypical antipsychotics is morewidely accepted than before in manic and hypomanic episode. Moreover, the preference for combination treatment in manicpatients who failed to respond in early stage treatment was increased. Conclusion Compared with the previous version, we found that ‘no-consensus’ decreases in this revision. These suggestthat the many clinicians agree with others in the treatment of acute manic/hypomanic episode, and the pharmacotherapy ofmanic/hypomanic episode become more obvious than before. Atypical antipsychotics such as aripiprazole, olanzapine andquetiapine gain more awareness in the treatment of bipolar mania and hypomania. We expect this algorithm may provide cliniciansgood information and help about the treatment of bipolar disorder, manic/hypomanic episode. 정신과적 질환의 약물치료의 발전에 따라, 이를 실제 임상상황에 맞도록 정리하여 제시하는 지침서 또는 알고리듬의역할은 점점 확대되고 있다. 이에 2002년 발간되었던 KMAPBP2002와 2006년 개정판(KMAP-BP 2006), 2010년 개정판(KMAP-BP 2010)에 이어 2014년판 한국형 양극성 장애 약물치료 알고리듬을 발간하였다. 본 개정판에서는 양극성 장애에 대한 근거자료의 축적과 치료 전략과 진단적 접근의 변화를 반영한 전문가들의 의견을 취합하였다. 모든 조증 유형에서 기분조절제(valproic acid 또는 lithium)와 비정형 항정신병약물의 병합 치료가 최우선 치료였으며, 경조증의 경우에는 기분조절제 혹은 비정형 항정신병약물 단독 치료가 1차 선택이었다. 급성기 조증의 치료에 사용하는 기분조절제로서는 valproic acid가 모든 형태의 조증에서 최우선 치료로 선택되었고, lithium은 모든 형태의 조증에서 1차 약물로 평가되었다. 기분조절제 단독 치료에 반응이없는 경우에는 비정형 항정신병약물을 추가하는 것이 최우선치료였으며, 단독 치료에 반응이 전혀 없다면 비정형 항정신병약물로 교체하는 것 또한 1차 치료로 평가되었다. 또한 비정형 항정신병약물 단독 치료에 반응이 불충분하다면 기분조절제를 추가하는 것이 1차 치료 전략이었다. 급성기 조증 삽화에 대하여 선호되는 비정형 항정신병약물은 aripiprazole,olanzapine, quetiapine, risperidone이었으며, 특히 혼재성 조증 및 정신병적 조증에서는 olanzapine이 최우선 치료로 선택되었다. 조증 삽화 부분에서 KMAP-BP 2014의 특징은 이전 판에비하여 유쾌성 조증에 대해서는 기분조절제 단독 치료의 선호도가 증가하고, 혼재성 조증에서는 기분조절제와 비정형항정신병약물 병합 치료의 선호도가 증가하였고, 비정형 항정신병약물 단독 치료에 대한 선호도는 개정을 거듭할수록증가하고 있다는 점이다. 이는 조증의 각 아형과 비정형 항정신병약물의 다양한 치료 효과에 대한 연구결과가 축적되고이해가 증가하면서, 증상의 특성에 따른 좀 더 특화된 치료가선호되고 있음을 의미한다고 할 수 있다. 또한 전문가들 사이에 컨센서스를 이루지 못한 항목이 이전에 비하여 줄어들어,조증 삽화의 치료에 대하여 많은 전문가들의 의견이 일치되고 있음을 알 수 있었다. 양극성 조증의 치료에 대해서는 지속적으로 새로운 약물이도입되고, 기존의 약물들의 치료적 적용에 대한 새로운 접근도 계속되고 있다. 향후 이러한 변화를 반영한 알고리듬의 제작과 실제 임상에서의 적용 효과에 대한 관심은 지속적으로필요할 것이다.

우리나라 企業資本構造의 實態分析

우영섭 경기대학교연구교류처 1990 論文集 Vol.27 No.-

Metformin을 투여하여 항정신병약물 유발 무월경이호전된 여성 조현병 환자 2예

우영섭,박원명 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.4

본 증례들은 항정신병약물의 투여 이후 발생한 무월경에 대하여 metformin을 500~1,000 mg/day 투여한 후 월경이 회복된 증례이다. 두 증례 모두에서 metformin을 투여한 이후 4~10주 이내에 월경이 회복되었으며, metformin 투여와 관련하여 신체적, 정신과적 부작용은 발견되지 않았다. 본 논문에서 보고된 2예만을 근거로 metformin의 무월경에 대한 효과를 입증하기는 어려우나, 많은 여성 조현병 환자에서 항정신병약물 치료에 문제를 유발하는 무월경 증상에 대한 치료적 대안으로 metformin을 고려할 수 있을 것으로 생각한다. 향후 잘 계획된 연구를 통하여 metformin의 무월경에 대한 효과와 그 기전의 규명이 필요할 것으로 생각한다. Amenorrhea is a common adverse event in female patients treated with antipsychotics. Because amenorrhea can produce difficulties for women suffering from schizophrenia, attempts should be made to alleviate antipsychotic-induced amenorrhea. We report two cases of female schizophrenic patients whose antipsychotic-induced amenorrhea were treated with metformin. Two patients who treated with metformin resumed their menstruation within three months. There was no adverse event reported during metformin treatment. This paper presents the rationale for the use of metformin for female patients who suffered from antipsychotic-induced amenorrhea through a literature review

치료저항성 우울증 환자의 양극성 경향

우영섭,채정호,서호준,송후림,전태연,김광수,박원명 대한정신약물학회 2006 대한정신약물학회지 Vol.17 No.5

Objective: In this study, we determined the prevalence of bipolarity in patients with treatment resistant depression (TRD) by investigating demographic and clinical characteristics, diagnostic subtypes, and illness outcome. Method: A medical record review of patients admitted to a university hospital with the diagnosis of major depressive disorder (MDD) was conducted. DSM-IV diagnoses at index hospitalization and six months after discharge and detailed clinical information were obtained. We categorized subjects into a TRD group or a non-TRD group and re-evaluated the patients using the recently proposed criteria for bipolar spectrum disorder(BSD). Patients in the TRD group were compared with patients in the non-TRD group with regard to the prevalence rate of BSD at the index hospitalization and at the end of the follow up period. Results: There were 281 patients diagnosed as MDD. At discharge, the number of patients who fulfilled the criteria for BSD was higher (p<.001) in the TRD group (32/68, 47.1%) than in the non-TRD group (8/213, 3.8%). At the end of six-month follow-up period, the diagnoses of 38 patients changed; 18 (26.5%) in the TRD group were subsequently classified as having bipolar disorder, and seven (3.3%) in the non-TRD group (p<0.001). There was no difference between these two groups in other clinical and demographic variables. Conclusions: The findings suggest that a large number of patients with TRD have a bipolar diathesis.

양극성 장애의 경과와 치료 순응도의 개선

우영섭,박원명 대한우울조울병학회 2006 우울조울병 Vol.4 No.-

초발 정신분열병 입원 환자에서 항정신병약물 치료에 따른 2년간 재입원율:예비연구

우영섭,육동현,서호준,채정호,전태연,박원명 대한정신약물학회 2007 대한정신약물학회지 Vol.18 No.2

Objective: We compared the rehospitalization rate of first-episode schizophrenic inpatients who were discharged from a university hospital while being treated with risperidone, olanzapine, quetiapine, or the conventional antipsychotic haloperidol. We also assessed other possible predictors of rehospitalization. Methods: We monitored the rehospitalization status of all first-episode schizophrenic inpatients who were discharged from a university hospital between 1 January 2001 and 30 June 2003 while they were taking risperidone (n = 16), olanzapine (n = 26), quetiapine (n = 9), or haloperidol (n = 10). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. Results: The rehospitalization rates estimated using the Kaplan-Meier formula for patients taking haloperidol (60.0%) did not differ significantly from the rates for patients treated with risperidone (37.5%), olanzapine (34.6%), or quetiapine (33.3%) during the 24-month follow-up period. The length of untreated illness before drug treatment predicted rehospitalization. Conclusion: The rehospitalization rates of first-episode schizophrenic inpatients taking risperidone, olanzapine, quetiapine, or haloperidol do not differ. However, the small number of patients who participated in this study made it difficult to establish significance. 본 연구에서는 초발 정신분열병 환자의 2년간의 의무기록을 조사하여 각 항정신병 약물에 따른 재입원율을 조사하였다. 연구대상에 포함된 환자는 61명이었으며 환자들은 ris-peridone(n=16), olanzapine(n=26), quetiapine (n= 9), haloperidol(n=10)을 처방받았다. 2년간의 연구기간 중 재입원한 환자는 risperidone 군 6명(37.5%), olanzapine 군 9명(34.6%), quetiapine 군 3명(33.3%), haloperidol 군 6명(60%)으로 비정형 항정신병약물들에 비해 hal operiol 군에서 많았으나 Kaplan-Meier 공식에 의한 생존분석 결과 통계적으로 유의하지 않았다. 추가적으로 시행한 Cox 회귀 모델에 의한 분석 결과 환자의 재입원율에 유의하게 영향을 미치는 인자는 발병 후 치료 개시까지의 기간이었다. 이러한 결과는 이전의 일부 연구들에서 나타난 비정형 항정신병약물간에는 재입원율의 차이가 없으나 전형항정신병약물과는 차이를 보인다는 결과와 다른 결과이다. 그러나 본 연구는 대상자수가 적어 그 의미를 일반화하기에는 어려울 것으로 생각되며 더욱 많은 환자를 포함한 추가적 연구가 필요할 것이다.

한국형 양극성 장애 약물치료 알고리듬 2022: 조증 삽화

우영섭,박원명,정종현,윤보현,서정석,추일한,양찬모,김원,이정구,심세훈,정명훈,전덕인,박성용,손인기,김문두 대한신경정신의학회 2022 신경정신의학 Vol.61 No.2

Objectives The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) is a consensus- based medication guideline. To reflect advances in pharmacotherapy for bipolar disorders, we updated KMAP-BP to provide more timely information for clinicians. Methods We conducted a survey using a questionnaire on treatments formanic/hypomanic episodes. Eighty-seven members among ninety-three members of the review committee (93.5%) completed the survey. Each treatment strategy or treatment option for manic/hypomanic episodes was evaluated with an overall score of 9, and the resulting 95% confidence interval treatment options were categorized into three recommendation levels (primary, secondary, and tertiary). The executive committee analyzed the results and discussed the final production of an algorithm by considering the scientific evidence. Results The combination of a mood stabilizer and an atypical antipsychotic, monotherapy with a mood stabilizer, or monotherapy with an atypical antipsychotic were recommended as the firstline pharmacotherapeutic strategy for the initial treatment of mania without psychotic features. The mood stabilizer and atypical antipsychotic combination was the treatment of choice, and atypical antipsychotic monotherapy was the first-line treatment for mania with psychotic features. When initial treatment fails, a combination of mood stabilizer+atypical antipsychotic and switching to another first-line agent is recommended. For hypomania, monotherapy with either mood stabilizer or atypical antipsychotic is the recommended first-line treatment, but the mood stabilizer+atypical antipsychotic combination is recommended as well. Conclusion It is notable that there were changes in the preferences for the use of individual atypical antipsychotics, and the preference for the use of mood stabilizer increased for treatment- resistant mania.